Heart disease is defined as any disorder that affects the heart's ability to function properly, and its most common cause is narrowing or blockage of the coronary arteries, which supply blood to the heart itself. The treatment for coronary artery disease is mainly by angioplasty and surgical revascularization, known as Coronary Artery Bypass Graft (CABG). Due to the nature of the disease, CABG has become one of the most commonly performed procedures in the world. Coronary artery bypass graft surgery (CABG) is a surgical procedure to restore blood flow to ischemic heart muscle whose blood supply has been compromised by occlusion or stenosis of one or more of the coronary arteries.
Coronary artery disease is mostly caused by localized blocks, with resultant disruption of blood flow and deprivation of heart muscle from energy and oxygen. In order to bypass a blockage in a coronary artery, native blood vessels harvested from other parts of the body—or rarely synthetic vessels—are connected to the blocked vessels beyond the lockage. The bypassing vessels are in communication with a source of arterial blood, mostly from aorta, and in other cases the internal mammary arteries. By doing so, the blood supply is resumed again to the continuity of the vessel beyond the blockage, and therefore to target heart muscle. The number of connections on heart usually corresponds to the number of significant blockages.
An important phase during CABG is the performance of the bypass itself where two blood vessels are joined in a process termed anastomosis. Anastomosis is the surgical joining of biological tissues, especially the joining of tubular organs to create intercommunication between them. Vascular surgery often involves creating an anastomosis between blood vessels or between a blood vessel and a vascular graft to create or restore a blood flow path to essential tissues. As in other anastomoses, the surgeon must securely and accurately suture the proximal end of each conduit to the patient's aorta in order to obtain a non-disturbed blood flow.
The procedure of bypass surgery is performed in majority of conventional cases through the midline incision and sternotomy to open the chest. During the past few years, however, there has been a movement away from open-chest surgery toward minimally invasive cardiac surgery. Minimally invasive cardiac surgery poses significant challenges for the surgeon. The CABG procedures presently being performed in a minimally invasive manner are typically carried out through incisions made between the ribs, which require the surgeon to operate with considerably less access to the heart and aorta as compared to open-chest. During minimally invasive procedures the anastomosis is performed by suturing the vessels and/or anastomosis connectors through the small incisions, usually using direct vision through regular magnifier loupes, by endoscopic instruments, or using video assisted vision.
At present, many vascular anastomoses continue to be performed by conventional hand suturing, with an open chest. The move to minimally invasive CABG, intended to reduce the morbidity of open heart CABG surgery procedures, has made evident the need for improved tools, devices and methods for performing anastomoses.